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Sunday, September 1, 2013

Obamacare’s Hierarchy of Privilege

On his radio show the other day, Hugh Hewitt caught me by surprise and asked me about running for the United States Senate from New Hampshire. My various consultants, pollsters, PACs, and exploratory committees haven’t fine-tuned every detail of my platform just yet, but I can say this without a doubt: I will not vote for any “comprehensive” bill, whether on immigration, health care, or anything else. “Comprehensive” today is a euphemism for interminably long, poorly drafted, and entirely unread — not just by the people’s representatives but by our robed rulers, too (how many of those Supreme Court justices actually plowed through every page of Obamacare when its “constitutionality” came before them?). The 1862 Homestead Act, which is genuinely comprehensive, is two handwritten pages in clear English. “The Patient Protection and Affordable Care Act” is 500 times as long, is not about patients or care, and neither protects the former nor makes the latter affordable.

So what is it about? On Wednesday, the Nevada AFL-CIO passed a resolution declaring that “the unintended consequences of the ACA will lead to the destruction of the 40-hour work week.” That’s quite an accomplishment for a “health” “care” “reform” law. But the poor old union heavies who so supported Obamacare are now reduced to bleating that they should be entitled to the same opt-outs secured by big business and congressional staffers. It’s a very strange law whose only defining characteristic is that no one who favors it wants to be bound by it.

Meanwhile, on the very same day as the AFL-CIO was predicting the death of the 40-hour week, the University of Virginia announced plans to boot working spouses off its health plan beginning January 1 because the Affordable Care Act has made it unaffordable: It’s projected to add $7.3 million dollars to the university’s bill in 2014 alone.

As Nancy Pelosi famously said, “We have to pass the bill so that you can find out what’s in it.” But the problem with “comprehensive” legislation is that, when everything’s in it, nothing’s in it. The Affordable Care Act means whatever President Obama says it means on any particular day of the week. Whether it applies to you this year, next year, or not at all depends on the whim of the sovereign, and whether your CEO golfs with him on Martha’s Vineyard. A few weeks back, the president unilaterally suspended the law’s employer mandate. Under the U.S. Constitution, he doesn’t have the power to do this, but judging from the American people’s massive shrug of indifference he might as well unilaterally suspend the Constitution, too. Obamacare is not a law, in the sense that all persons are equal before it, but a hierarchy of privilege; for example, senators value their emir-sized entourages and don’t want them to quit, so it is necessary to provide the flunkies who negotiated and drafted the Affordable Care Act an exemption from the legislation they imposed on the citizenry. Once again, the opt-out is not legal. As the Wall Street Journal trenchantly observed, “OPM has no authority to pay for insurance plans that lack FEHBP contracts, nor does the Affordable Care Act permit either exchange contributions or a unilateral bump in Congressional pay in return for less overall compensation.”

OPM has no authority to pay for plans that lack FEHBP? Who knew?

Despite being the presumptive next senator from New Hampshire, I am in fact an immigrant, and, although I do my best to assimilate, I never feel more foreign than when discussing “health” “care” “reform.” Across the planet, my readers from Tajikistan to Tuvalu are wondering: Is an OPM a new kind of procedure? Is it the latest high-tech stent or prosthetic? But, no. Nothing in the health-care debate is anything to do with medicine or surgery, only with OPMs and FEHBP and the death of full-time employment.

What does your employer or (for the discarded husbands of the University of Virginia’s Women’s Studies Department) your spouse’s employer have to do with health care? For most of modern history, your health care was a matter between you and your doctor. Since World War II, in much of the developed world, it’s been between you, your doctor, and your government. In America, it’s now between you, your doctor, your government, your insurer, your employer, your insurer’s outsourced health-care-administration-services company . . . Anybody else? Oh, let’s not forget Lois Lerner’s IRS, which, in the biggest expansion of the agency in the post-war era, has hired 16,500 new agents to determine whether your hernia merits an audit.

All third-party systems are crappy and inefficient. But socialized health care has at least the great clarifying simplicity of equality of crappiness: liberté, égalité,merde. It requires a perverse genius to construct a “health” “care” “reform” that destroys everything from religious liberty to full-time employment, while requiring multitudes of new tax collectors and other bureaucrats and ever fewer doctors and nurses. The parallel public/private systems of Continental Europe cost about 10 percent of GDP. The Obamacare monstrosity blends all the worst aspects of a private system (bureaucracy, restricted access, co-pays) with all the worst aspects of a government system (bureaucracy, restricted access, IRS agents) and sucks up twice as much GDP, ever less of which is spent on “health care” and ever more on the intervening layers of third, fourth, fifth, and sixth parties.

But, as the AFL-CIO’s resolution emphasizes, that hardly begins to state the distorting effects of Obamacare. In my part of the world, a common employment profile is for the husband to have his own one-man business, doing construction all summer and snowplowing all winter, while the missus does an administrative job with the school district or some other government or quasi-government racket in order to get health coverage. In my experience, most of the people who do the latter don’t terribly enjoy it: They take the job mostly for the health care. So it’s un-American, in the sense that it requires them to sacrifice the pursuit of happiness for the certainty of low-deductible plans.

But it also has a broader destabilizing effect: As I noted a couple of weeks ago, at the low end, about 40 percent of Americans now do minimal-skilled service jobs — the ones that, in the wake of Obamacare, are becoming neither full-time nor part-time but kinda-sorta two-thirds-time in order not to impose health-insurance obligations on the employer. In the middle, a similar number of Americans are diverted into those paper-shuffling jobs that do provide health benefits — say, in the “human resources” department of the bureaucracy; the kind of job in which you pass the time calling someone in Idaho to say you need them to fill in a W-9 before you can send them a 1099, or vice versa. And, at the top end, privileged Americans spend six-figure sums acquiring college degrees that admit them to an homogenized elite that tells itself Obamacare makes perfect sense for everyone except them. The U.S. economy can never recover until more of its real “human resources” are engaged in genuine wealth creation. Yet Obamacare instead incentivizes the diversion of more and more manpower into the Republic of Paperwork.

The cynical among us have always assumed Obamacare was set up to be so unworkable a grateful populace would embrace any 2016 Democrat promising single-payer health care. The way things are going the entire system may collapse first. If any Republicans are trying to devise a health system that doesn’t involve employers, the IRS, and paperwork without end, they’re keeping awfully quiet about it.